ResumenEl origen traumático de la hernia discal es una cuestión relevante en Medicina Legal. El presente trabajo realiza una revisión de las causas de las hernias y protrusiones discales, en especial del papel de los factores mecánicos en su origen. Se concluye que el origen de la hernia discal es multifactorial (genético, bioantropométrico, metabólicos, de entorno), así como que las hernias traumáticas puras son excepcionales, ocurriendo corrientemente sobre discos ya degenerados. Se revisan los signos radiológicos y clínicos de degeneración espinal, así como aquellos que pueden denotar un origen traumático de la hernia. Ante una hernia discal después de un accidente, el perito deberá valorar siempre la posibilidad de un estado anterior, así como el papel del accidente en una eventual descompensación o agravamiento del mismo. Se propone una clasificación de la causalidad tanto para la valoración del grado de la misma como para la modalidad del papel del estado anterior.Palabras clave: Hernia de disco. Traumatismos espinales. cambios degenerativos. Causalidad médica. Hernia de disco traumática. AbstractTraumatic origin of disc herniation, remains as a relevant Medico-Legal problem. The present paper makes a disc protrusion/herniation revision, mainly about mechanic and traumatic factors involved in their origin. A multifactorial (genetic, bio-antropometric, environnement, metabolic, etc.) causation is concluded to explain etiology of disc herniation. Pure disc herniation (occurring in a healthy non degenerated disc) is considered an exceptional phenomenon. Clinical and radiological spine degeneration sings are revised, along with others that can point to a traumatic origin. Dealing with a disc herniation after an accident, Medical Expert has always to consider the possibility of a precedent disc damage status, assessing the role of a worsening of such antecedent condition in each case. A classification of degree of causation accident-herniation, and antecedent disc damage decompensation are proposed. IntroducciónEl origen de las hernias de disco es una cuestión todavía debatida que incluye factores genéticos, degenerativos, bioquímicos, traumáticos, y otros. Entre estas etiologías, la acreditación de un origen traumático constituye el principal problema médico-legal. En España, la hernia discal es considerada accidente laboral cuando se produce en el trabajo. Igualmente, los baremos de indemnización por daño corporal consecutivo a accidentes de circulación la contemplan como secuela. Ambas regulaciones admiten, por tanto, implícitamente la posibilidad de un origen traumático.Sin embargo, otras legislaciones, como la alemana, consideran que la causa de la hernia discal es degenerativa, y el eventual accidente marca únicamente el momento de la manifestación del daño 1 . Bajo este enfoque, la alteración discal es siempre preexistente, actuando el traumatismo como un factor que hace dicho daño clínicamente evidente.
ResumenCespace es un implante diseñado para conseguir la fusión intervertebral cervical sin injerto óseo. El implante está hecho de titanio y recubierto con plasmapore (polvo de titanio puro). El crecimiento óseo a través de la microestructura de titanio es inducido por el plasmapore, y la fusión se consigue progresivamente una vez que la inducción ósea ha terminado.Desde Los resultados clínicos fueron buenos en el 85.5% de los pacientes (N=89). La estabilidad primaria se obtuvo en todos los casos. La estabilidad secundaria (fusión) fue evidente después de 1 o 2 años en todos los implantes, confirmando la capacidad del plasmapore para la inducción de hueso sin injerto óseo.No se registraron complicaciones específicas del implante (pseudoartrosis, hundimiento, inestabilidad, etc) en ningún caso.Concluimos que la microdiscectomía radical y el implante con caja Cespace constituye un buen procedimiento para el tratamiento de la radiculopatía o mielopatía causadas por una hernia discal o espondilosis, evitando el injerto óseo y consiguiendo altas tasas de fusión cervical. En algunas fracturas cervicales asociadas a inestabilidad, el sistema Cespace puede ser usado como un sustituto fiable del injerto óseo intervertebral en combinación con placa de fijación anterior.PALABRAS CLAVE. Cespace. Microdiscectomía cervical. Fusión vertebral. Cajas de titanio. Plasmapore Cespace. Cervical interbody fusion system. Preliminary retrospective study in 104 cases (120 implants) SummaryCespace is a cervical implant designed to obtain intervertebral fusion without bone grafting. The implant is built in titanium and coated with plasmapore (a sort of pure titanium powder). Bone growing through titanium microstructure is induced by the plasmapore, and fusion is progressively obtained once this boneinduction is completed.From January 2002 to December 2008 we operated upon 104 patients employing this implant at one or two cervical spine levels. The more frequent condition was radiculopathy caused by disc herniation or spondilosis (N= 85; 81.7%), followed by mielopathy (N=13; 12,5%). Six cases (5.7%) corresponded to cervical fractures or dislocations. In these latter ones Cespace was implanted as a method of spinal stabilization combined with Caspar plates, avoiding bone grafting.The total number of Cespace implants placed was 120.Clinical results were good in 85,5% of patients. Primary stability was obtained in all cases. Secondary stability (fusion) was evident after 1 to 2 years in all cases, confirming the bone-induction capability of plasmapore without bone grafting.No specific implant complications (pseudoartroses, settling, instability, etc) were registered.We conclude that radical microdiscectomy and Cespace box implant constitutes a good procedure for the treatment of cervical radiculopathy or mielopathy caused by disc herniation or spondylosis, avoiding bone grafting and providing high rates of vertebral fusion. In some cervical fractures associated to instability, Cespace can be used as a reliable substitute of intervertebral bo...
Poly-ether-ether-ketone (PEEK) cages have lower modulus of elasticity when compared with Titanium (TTN) cages. This suggests that PEEK-cages could show a lower rate of subsidence after anterior cervical discectomy-fusion (ACDF) and might lead to a lower loss of correction. We investigated the one to five year-results of standalone PEEK-TTN-porous coated cages in a patient cohort from 2014 to 2017. The patients underwent single-level ACDF for disc herniation and degenerative discopathy. Clinical and radiological outcome were assessed in 50 eligible patients after a mean of 27 months. Results: Solid arthrodesis was found in 84%. Neck disability index (NDI), and visual analogue scale (VAS) of neck and arm show comparable results to the literature. Conclusions: Clinical and radiological outcomes of ACDF with PEEK-body-cages with a porous coated surface show good bony integration. The modulus of elasticity, design, shape, size, cage surface architecture, as well as bone density, endplate preparation, radical microdiscectomy and distraction during surgery should be considered as important factors influencing the clinical results. One main advantage, over titanium cages, is the absence of MRI artifacts, allowing an excellent postoperative follow-up.
The case presented includes a left temporal bone from an individual exhumed from the Hispano‐Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries bc. External examination and computed tomography images show lesions in the external acoustic canal, in the form of diffuse widening, suggestive of a cholesteatoma originating in this canal, with invasion of the middle ear through the tympanic membrane. The difficulties with examining the internal elements of the ear are discussed, which causes the underestimation of these diseases in paleopathology studies.
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